How Do You Treat Angular Cheilitis in General Practice (GP)?

Angular cheilitis, characterized by painful cracks or sores at the corners of the mouth, is a condition commonly encountered in general practice. While it might seem minor, its impact on a patient’s quality of life can be significant, making timely diagnosis and treatment essential. This article delves into how GPs approach the diagnosis, management, and treatment of angular cheilitis, ensuring patients receive effective care.

Understanding Angular Cheilitis in General Practice

General practitioners (GPs) often serve as the first point of contact for patients presenting with angular cheilitis. Their role involves:

Identifying Symptoms: Redness, inflammation, cracks, and discomfort at the corners of the mouth.
Determining Causes: Factors like fungal infections, bacterial infections, or underlying conditions such as nutritional deficiencies or diabetes.

GPs must also consider the patient’s history, lifestyle factors, and any associated medical conditions to tailor their treatment approach.

GP Approach to Diagnosis

1. Patient History

A detailed medical history helps identify contributing factors:

Skin conditions: Eczema, psoriasis, or dermatitis.
Systemic illnesses: Diabetes, anemia, or immune deficiencies.
Lifestyle habits: Lip licking, poor oral hygiene, or ill-fitting dentures.

2. Physical Examination

The GP examines the affected area for clinical signs:

Cracks or fissures at the corners of the mouth.
Erythema (redness) and scaling.
Possible signs of infection, like white patches (fungal) or pustules (bacterial).

3. Swabs or Tests

For recurrent or severe cases, a GP may:

Take a swab from the affected area to identify the organism (fungal or bacterial).
Order blood tests to check for nutritional deficiencies (iron, zinc, or B vitamins) or underlying conditions like diabetes.

Treatment of Angular Cheilitis in General Practice

Once the diagnosis is confirmed, the GP designs a treatment plan addressing both symptoms and causes.

1. Topical Treatments

GPs typically prescribe topical medications based on the cause:

Antifungal Creams: Clotrimazole or miconazole for fungal infections (Candida albicans is a common culprit).
Antibacterial Creams: Mupirocin or fusidic acid for bacterial infections.
Barrier Creams: Zinc oxide or petroleum jelly to protect the area and prevent further irritation.

Application Advice:
Patients are advised to apply the cream two to three times daily and maintain the area dry and clean.

2. Addressing Nutritional Deficiencies

If blood tests reveal deficiencies, GPs recommend supplements:

Iron: Supplements or iron-rich foods like spinach, lentils, and lean meats.
Vitamin B Complex: Riboflavin or B-complex tablets.
Zinc: Supplements or dietary sources like seeds, nuts, and seafood.

3. Lifestyle and Dental Advice

GPs may offer practical advice to prevent further irritation:

Lip Care: Encourage patients to avoid licking their lips and use protective lip balms.
Hydration: Advise drinking plenty of water to avoid dryness.
Dental Adjustments: Refer patients with ill-fitting dentures or dental issues to a dentist for proper fitting and care.

4. Treating Underlying Conditions

GPs play a crucial role in identifying and managing systemic issues contributing to angular cheilitis:

Diabetes Management: Monitor and control blood sugar levels.
Dermatitis or Psoriasis: Prescribe corticosteroids or other treatments to manage flare-ups.
Immune Deficiencies: Work collaboratively with specialists for comprehensive care.

Common Scenarios in General Practice

Mild to Moderate Cases

Treatment: Topical antifungal or antibacterial creams with barrier protection.
Outcome: Symptoms typically resolve within 1–2 weeks.

Recurrent or Severe Cases

Treatment: Combination therapy, addressing underlying conditions, and referral for specialized care.
Outcome: Longer recovery but manageable with appropriate intervention.

Prevention Tips Offered by GPs

GPs educate patients on preventive measures to avoid recurrence:

Maintain proper oral hygiene.
Use moisturizers or lip balms regularly, especially in dry or cold climates.
Eat a balanced diet rich in vitamins and minerals.
Avoid habits like lip licking or pulling at the corners of the mouth.

Final Thoughts

GPs play a vital role in diagnosing and managing angular cheilitis. By combining effective treatments, addressing root causes, and providing preventive advice, they ensure patients achieve a speedy recovery. If you experience persistent or recurrent symptoms, consult your GP promptly to explore tailored solutions for relief.

Medical & Dental